Yu Bin, Zhang Jian-guo, Qiu Gui-xing, Wang Yi-peng, Zhao Hong, Li Shu-gang, Zhao Yu
Department of Orthopaedics, Peking Union Medical College Hospital, CAMS and PUMC, Beijing 100730, China.
Zhonghua Yi Xue Za Zhi. 2009 Sep 22;89(35):2495-9.
To evaluate the safety and efficacy of apical pedicle subtraction osteotomy (PSO) in the treatment of severe kyphoscoliosis.
The radiographic films of the 12 severe kyphoscoliosis patients treated with apical pedicle subtraction osteotomy were retrospectively reviewed, and the Cobb angles of the scoliosis and kyphosis and coronal trunk balance were measured and analyzed. Medical records and operation charts were reviewed to record any peri-operative complications.
Twelve patients were included in this study, 4 males and 8 females, with an average age of 20.1 years old. Of the 12 patients, 2 were adult kyphoscoliosis and 10 were congenital kyphoscoliosis. The mean follow-up time was 9.2 months. The mean fusion levels were 12 segments and the mean operation time was 5.0 hours. The mean estimated blood loss during operation was 1517 ml and the mean autotransfusion and allotransfusion were 780 ml and 1109 ml, respectively. The mean preoperative and postoperative coronal Cobb angle of the main curve was 100.9 degrees and 48.8 degrees , with an average correction rate of 51.8% (P = 0.000). The mean preoperative and postoperative sagittal Cobb angle of the kyphosis was 81.7 degrees and 42.2 degrees , with an average correction rate of 49.8% (P = 0.000). At final follow-up, the mean Cobb angles of the scoliosis and kyphosis were 50.7 degrees and 46.0 degrees , respectively, and no obvious correction loss was found (P = 0.763, P = 0.698). The mean coronal trunk balance before, after surgery and at final follow-up was 16.3 mm, 14.7 mm, and 12.0 mm, respectively. Only 1 patient had trunk shift greater than 20 mm at final follow-up. After operation, two patients suffered from transient numbness and weakness of the unilateral lower extremity with complete recovery in one week. No spinal cord injury occurred.
Apical pedicle subtraction osteotomy can be easily performed in the treatment of severe rigid kyphoscoliosis with satisfactory correction results and few neurologic complications.
评估顶椎椎弓根截骨术（PSO）治疗重度脊柱侧凸畸形的安全性及有效性。
回顾性分析12例行顶椎椎弓根截骨术治疗的重度脊柱侧凸畸形患者的影像学资料，测量并分析脊柱侧凸及后凸的Cobb角及冠状面躯干平衡情况。查阅病历及手术记录，记录围手术期并发症。
本研究共纳入12例患者，其中男性4例，女性8例，平均年龄20.1岁。12例患者中，2例为成人脊柱侧凸畸形，10例为先天性脊柱侧凸畸形。平均随访时间为9.2个月。平均融合节段为12个节段，平均手术时间为5.0小时。术中平均估计失血量为1517 ml，平均自体输血及异体输血分别为780 ml和1109 ml。主弯术前及术后冠状面Cobb角平均分别为100.9°和48.8°，平均矫正率为51.8%（P = 0.000）。后凸术前及术后矢状面Cobb角平均分别为81.7°和42.2°，平均矫正率为49.8%（P = 0.000）。末次随访时，脊柱侧凸及后凸的平均Cobb角分别为50.7°和46.0°，未发现明显的矫正丢失（P = 0.763，P = 0.698）。术前、术后及末次随访时冠状面躯干平衡平均值分别为16.3 mm、14.7 mm和12.0 mm。末次随访时仅1例患者躯干偏移大于20 mm。术后2例患者出现单侧下肢短暂麻木及无力，1周内完全恢复。未发生脊髓损伤。
顶椎椎弓根截骨术治疗重度僵硬性脊柱侧凸畸形操作简便，矫正效果满意，神经并发症少。
